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Crude self-examination is always an aftermath of loss. In the beginning, it is usually involuntary. It is impulsive. It is primitive, unrefined. It is based on emotion, not characterized by careful thought. It is a clear and often painful part of the grief process. As mourners, we question our own participation in the dying of the loved one. At first, our “wrong” moves tend to take precedence over work well done. Those wrongs become an obsession, at least for awhile. The thoughts are repetitive, and they hurt. That is self-condemnation. As mourners, we question how we might have failed the loved one during the dying. In our mind, our imagination, the failures could have led to increased suffering and a sooner death. Increased suffering and a sooner death are unacceptable outcomes for us, most especially if we ourselves caused what could otherwise have been averted.

In our deepest mind, the “heart of hearts,” we are asking ourselves if we actually caused the death. Did I do that? In any sense, did I kill? This is the fear of failure. Our best efforts at good care of the dying might not have been good enough. Perhaps, and certainly unintentionally, we failed the loved one at the crucial moments of his dying. And worse, the dying loved one might have realized that failure. We fear that he may not have forgiven the failure. This fear is virtually always irrational, but that never stopped the questioning mind.

The runaway thoughts do not easily, immediately come under our control. We seek perfection. We are imperfect beings. Being imperfect is intolerable, way down inside us. We expect more from our selves. Unrealistic expectations of self are part of the grief mindset after loss. They require reworking – grief work. Only the reworking brings relief. That relief is hard-won, a victory not easily achieved. In the meantime, the question of killing remains, primitive and fierce. Intense and distracting. A monster so painful to tackle and tame.

We question if we have lived up to the expectations that were held by the loved one. Those expectations are often an expression of our own thinking rather than the ideas coming from the loved one. We become self-critical. And of course, the criticism of self has a purpose: situational control. If I did it, then I have the power – the control – also to undo the harm. The power to undo, and thereby to exercise control, is effective in many circumstances.1 The only problem here is that the loved one died, so the power to undo is then blocked, denied by death. A dead end, so to speak. That hurts again, and it causes agitation. It is a feeling that must somehow be managed. That is not so easy.

Also, we wonder if we are now unlovable – expendable, disposable, unnecessary. Not worth salvaging. If we did not meet the loved one’s high expectations, perhaps love was, or will be, withdrawn from us. To be unlovable is a fearful and grim verdict. If that verdict is shared by others who are still living, the world would be a lonely place indeed. The reason is that there is nothing more important in life than human connection. If we are denied the love of others, it would feel like solitary confinement in the prison of the self, and perhaps annihilation of the self.2 Complete abandonment. That is the most unbearable of all thoughts. A living death. “Every profound experience of suffering is a form of disintegration. The world we had taken for granted is no longer there. Something is missing, lost. A bond connecting us to reality is broken, and the result is cognitive crisis.”3

Our thoughts spin out of our control at first, usually surprising us. Caught off guard. A seemingly small question in our minds can lead to a spiraling swirling series of thoughts. Those thoughts bring us to drastic, dramatically horrifying conclusions about our own worth and dignity. The grief pain then becomes exponentially worse. Fear feeds on fear. Anxiety peaks. The fear is momentarily realized. We are convinced that we have failed the loved one.

Often, suddenly, fear turns to anger at those who provoked it4. The stronger the fear, the deeper the outrage. The phrase “You scared me!” is an accusation. It implies the imperative, “Don’t do that!” It is a counteraccusation to the imagined accusations of failure conferred by the loved one. It demands freedom from fear, recognition of the wrongdoing, and an apology. Self-preservation is instinctive. We defend ourselves naturally, spontaneously, automatically. The mind repeats a plea, “It’s not my fault (is it?)!” Now we are trying to save our own moral lives. We virtually always succeed, but not without effort. Not without others.

We must understand what is happening inside ourselves and how we are changing. We need to make sense of loss and how it permanently changes our minds. A little further educated and carefully reasoned self-awareness – insight – is one of the most successful glide paths. Slowly, it can return a degree of self-control and quiet the unsettled senses. It is part of the grief work. It is particularly helpful if it is shared with others. Talking about fears of failure can be useful and constructive. Others who feel concern and compassion will be able to reconfirm the mourner’s worth and dignity, self-respect, and sanity. “Grief is really a social process and is best dealt with in a social setting in which people can support and reinforce each other in their reactions to the loss.”5

In reality, we are not alone. Reaching out and talking about the fear of failure can soothe and relieve a broken sense of sound judgment. We seek rational thinking. We live in a social world. Others matter. We matter to others. Allowing them to help is also helping them. Amazing how a bit of well-placed conversation can awaken and restore our own mental “immune system.” It boosts self-healing mechanisms. We are strengthened and grow not only by our own solitary efforts but decidedly also with the assistance, reinforcement, and encouragement of others.

We make our own monsters. Then we fear them for what they might show us about ourselves.6 Together, we have the power to name them and to tame them.

Sometimes the questions are complicated and the answers are simple.7 Grief is not a mental illness, no matter how long. Pain is not pathology.8 Emotions make sense, and thoughts don’t kill. We are still worthy, even in crisis. We matter because we are.9 Reach out. Find others who care. Talk about it. That is a good-enough start. That is healthy. Talking returns balance to lost perspective. It preserves the image of the loved one. It can be a gift to others, too. Helping is healing. That is a route to greater self-respect, to dignity renewed. That is therapeutic. It prepares us for peace.

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References & Notes:

1. “Undoing” can be defined as: the act of reversing or annulling something accomplished; a cancellation (American Heritage Dictionary). Examples of “undoing” in this everyday-life context are: making an apology, saying “I didn’t mean it that way,” giving an explanation, asking forgiveness. The term used here is somewhat different from the one first proposed by Sigmund Freud in 1909: “undoing” intended as a mechanism of defense. That defense mechanism was seen as largely unconscious. This Freudian concept was later further developed by Anna Freud (the founder of psychoanalytic child psychology) and others in the psychoanalytic community. In the analytic conception, the purpose of undoing is to protect the ego against the id – against the demands of instinctual forces. In the everyday term used here, undoing is an open, conscious effort to reduce or avoid anxiety. It is a conscious defense against anxiety. In a very real sense, it is an attempt to change the past. It can be valuable also in adapting our responses to future misfortune and threats to self-esteem.

4. One alternate route with high risk is depression; simply said, anger turned inward against the self. It is a risk to be avoided, if we finally have enough emotional control to make a choice. Healthy ways to grow forward are preferable to sickness. Grief itself is not a depressive disorder. It is not a mental illness. It is not a sickness regardless of some seemingly similar symptoms. It should not be mistaken for, or labeled as, a “major depressive disorder.”

“And when great souls die, after a period peace blooms, slowly and always irregularly. Spaces fill with a kind of soothing electric vibration. Our senses, restored, never to be the same, whisper to us. They existed. They existed. We can be. Be and be better. For they existed.”

— Maya Angelou, from the poem: “When Great Trees Fall”

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Rea Ginsberg is a retired director of social work services, hospice coordinator, and adjunct professor of clinical social work. She can be reached on LinkedIn and on Twitter @rginsberg2.

"It's OK to Die" is a ground-breaking book filled with graphic stories straight out of the Emergency Room illustrating how most Americans are completely unprepared for death and dying. In response, the authors have created a unique and comprehensive guide urging EVERYONE to prepare in advance, to assure their own peace and to prevent the suffering of their loved ones. Learn More..

Some mourners have no social support or aren’t aware of the support that is available. Learning to respond to the bereaved with support that does not amplify their worst fears is a skill we must all try to develop.

My view is that we are never alone, that some sort of “support system” is within reach of everyone — even if it is institutional rather than individual person-to-person.

It is never easy to accurately gauge the level of another person’s anxiety. (It is often difficult enough for us to gauge our own level of anxiety.) Insofar as the grief counselor can do it successfully, the anxiety level of the mourner must always be respected.

And then there is the profound grief, the “not being there”, the additional layers or guilt, the unfinished business after a suicide. The monster becomes two headed, as we face (or not face) the “whys”, before, during and after struggling to face the loss itself. Thank you Rea, your post is timely and helpful.

my comments start with saying this is an excellent writing on a major piece of grief work. i think that the sense of failure in regard to the loved one goes beyond the dying process. it is all the what ifs-why didn’t i notice something was wrong why didn’t i make him/her go to the doctor? we also what if about how we feel we may have failed the loved one during their life-the entire length of their life. what ifs are again about control-they are the attempt to make it otherwise-the wish that somehow things could be different. it is also part of being faced with ones own mortality and the desire to think that if i do everything right perhaps this won’t happen to me. so we attempt to find mistakes,so we can do otherwise and escape the fate that we cannot escape-our own inevitable demise and not in our control of when and how. grief is indeed a sense of failure but it can also be a wake up call we wish not to recieve.

Thank you for your interesting and extensive comments, Donna! Yes, the rise of the What-If! And what if we could undo what we did?? And perhaps to undo will make us immortal…? It is quite a thought train…! Nice to find you onboard.

Thank you for a wonderfully thought provoking piece, Rea. You’ve really hit the nail on the head. It brought up a lot of personal issues which I thought were already “dealt” with.

While, our hospice families are fortunate enough to have an incredible “support system,”
there are many that aren’t so lucky. We know that bereavement services are available to everyone, whether or not the patient died on hospice. I don’t think most people are aware of these services. If a non-hospice patient dies in the hospital, they may have the benefit of a social worker who can guide the family. If the patient was sick for a long time, hopefully, the PMD would begin that conversation. (The patient probably should have been referred to hospice; but that’s another topic.) I do agree with Randall that there are people who go through the grieving process alone.

Patti, thank you, also, for interesting comments! Yes, you are so right: those “personal issues” find us sometimes long afterwards. It’s always the “right” time to deal with the leftover issues and to grow. Grief isn’t scheduled and has no use-by date.

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